Uncertainties surround Affordable Care Act for businesses

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It has been called confusing, aggravating and unworkable by many, and a godsend by others.

It is the Affordable Care Act, and private companies and even insurance carriers are still trying to figure out what it all means.

Also known as Obamacare, the ACA and its implications for businesses large and small and how companies can save money in the new health care universe were topics of a roundtable discussion Thursday at The Daily Transcript offices sponsored by Anthem Blue Cross and Health Savings Associates.

"This is probably the most radical change we've ever had in the health care marketplace," said Steven Scott, an Anthem Blue Cross vice president and general manager.

Along with scrambling to meet changing deadlines, individuals and companies are faced with a tiered-plan system with coverage from bronze (the cheapest) to platinum offerings.

Brad Chapin, sales director for Health Savings Associates, said he personally hasn't processed any gold or platinum plans but doesn't believe they are necessary.

"It's not worth the money you would spend, and 95 percent of people won't even come close to reaching their deductibles," Chapin said.

Scott said that premiums not only differ by carrier and levels, but also where the employees live in the state.

"When you look at the pricing, it can be a mystery," Scott said.

Scott said companies and individuals need to shop around to determine what is a fair price for a given procedure.

"Is a $10,000 bill from a hospital really a $10,000 bill?" Scott asked. "The consumer needs to know what services should cost."

Scott added that there is an enormous range of prices for medical procedures.

"In the state of California, the price for a hip replacement ranges from $11,000 to $110,000. This is madness," Scott said. "You ought to be able to get this for $30,000 anywhere."

Chapin said his firm is consulting with businesses so health care costs don't cause a fiscal hemorrhage.

"Paychecks are impacted by health care more than any other expense," Chapin said.

Roy Paulson, president of Temecula-based Paulson Manufacturing Corp., which makes clear shields for face protection for police and fire applications, also said the health care portion of his expenses has increased rapidly over time.

"It's a fairly significant cost," Paulson said.

While Paulson has been able to reduce the company's premiums by 26 percent by farming out the insurance functions to a company that specializes in such services, his employees were still taken aback by the high deductibles in the plans.

Paulson said because of his increased health care expenses, he is planning to make his business more automated. Edward Plant, president of Harborside Refrigerated Services, has done this already.

"We're also doing more with fewer people," Plant said.

Dane Chapin, Brad's brother and owner of Health Savings Associates and the USAopoly game company, said the ACA expenses would cause his chief financial officer's premium to nearly double from $900 to $1,750 per month if he stayed with the same Blue Shield of California plan.

"That's a huge disincentive to hire workers," Dane Chapin said.

Like many, the Chapins are now working together to look for another carrier.

Plant, who has 70 employees on its payroll, said he doesn't know how many of these workers (other than unionized longshoreman) will be able to pay for their insurance.

Darren Rawson, president of Steren Electronics Group, said he has run into situations in which employees, but not their dependents, get coverage.

"If a family member doesn't get covered and they get sick, that employee could quit," Rawson said.

Scott Griffiths, president of R&F Products Inc., which manufactures radar-absorbing material for military aircraft, said many of his employees use the emergency room rather than getting a health plan and a checkup that might have prevented a more critical situation.

Rawson added that many of his employees go to Tijuana for their care "and I have yet to hear that they got worse service."

"That's not an answer," Brad Chapin countered.

Scott, whose Anthem Blue Cross firm covers more than 60,000 employers in California, said all the health care changes also bring up the question of how many hours a person needs to work before being covered.

Tracy Polzin, Cubic Corp. human resource director, said her locally based firm provides health care via Cigna insurance for every employee who works at least 20 hours per week.

Polzin, who said her company "is very high on wellness," said Cubic has a program whereby if an employee agrees to have a biometric screening and completes a health assessment, the company is able to freeze the cost of the premiums for a year.

Brad Chapin said whether the ACA is in full force or not, preventive care is the secret of a company's and an individual's ability to control costs.

"Eighty percent of all claims are preventable," Chapin said.

Chapin added that one of the few things he likes about the ACA is that annual checkups are free.

Chapin said Safeway Corp. (NYSE: SWY) has the most aggressive preventative program of any company he knows.

Prescription drugs, particularly those that don't have a generic equivalent, are another factor in the health care equation.

"Prescription drugs are about 20 percent of the health care costs today," Scott said. "To give you an idea about the costs, the charge for a full course treatment of a new Hepatitis C drug is $84,000," Scott said.